this post was submitted on 10 Sep 2024
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I've been fighting with my insurance company since May. My wife had a medical emergency and I had to take her to the ER at 3AM on a Sunday. The team of doctors treating her all agreed she needed to be hospitalized and have emergency surgery. She was admitted and underwent surgery and was out in three days.
A week after she was discharged we received a letter from the insurance company letting us know they had decided not to cover the $67k hospitalization bill because they had decided it wasn't medically necessary.
So yeah, that's great. Not to mention we had finally hit our $6,000 deductible (after I had cardiac issues and ended up in the ER the previous month) so insurance would finally have had to actually pay something.
So glad we pay them $1500 a month for them to make decisions on what is medically necessary and what constitutes an emergency after the fact.
First. I hope your family is OK.
Second its total bullshit the medical insurance companies can just declare something isn't needed (usually by a doctor on thier payroll). Then use that as a justification to decline coverage.
This is supposedly a standard tactic for them too. Decline all big claims and see who fights it.
That's insanely immoral especially because anyone with a huge medical bill clearly has some shit going on and the last thing they need is the massive stress of a massive medical bill.
We have movies and TV shows that poke at how bad our medical coverage is and we Americans just accept that the plot is acceptable.
The ones that come to mind are:
The Rainmaker kid dies of lung cancer because insurance declined treatment due to it being "experimental".
Breaking Bad yeah. Cooking meth to pay for cancer treatment
They should be held legally to prove why the procedure is not necessary only then they can refuse the claim. Otherwise they have to provide the claim. This should be the law.